Hospitals Ask Permission to Perform Non-Emergency, Elective Angioplasties

Andrew Kitchenman | June 1, 2015 | Health Care
State considers allowing 11 hospitals that participated in national project to continue offering procedure

angioplasty heart surgery
The capacity of New Jersey hospitals to offer elective angioplasties — procedures typically used to open blocked or narrowed arteries — has long been the subject of debate. And the discussion is heating up again as the state considers changing the rules that apply to these procedures.

What makes the conversation hard to follow is that it’s taking place on at least two fronts.

The state Department of Health currently allows 18 hospitals — all of which have cardiac surgeries onsite — to offer elective angioplasties.

However, another 11 hospitals — without cardiac surgeries — also offer the procedure. They were allowed to do so in a national study that determined patient outcomes were similar at hospitals with or without cardiac surgeries.

The proposed rule change would allow those 11 hospitals to continue to perform the procedure on an elective basis.

But hospitals that did not participate in the study argue that they also should be permitted to perform the procedure, citing the results of the study as part of their argument. They also note that several counties have no hospitals that offer angioplasties, which forces patients to travel.

To further complicate the issue, some healthcare advocates want the state either to restrict elective angioplasties to the 18 hospitals with cardiac surgeries, or to at least require patients to be informed of the potential risks of choosing to have an angioplasty at a hospital without a cardiac surgery.

The stakes are significant, since elective angioplasties are profitable for hospitals.

Peter Kaprielyan, a vice president for Inspira Health Network, pointed to a study published in the New England Journal of Medicine in 2012 that found that that the post-procedure rates of deaths and of serious heart problems were similar for procedures performed at hospitals with and without cardiac surgeries.

Inspira would like to have elective procedures at its two hospitals that already offer emergency angioplasties, Inspira Medical Center Vineland and Inspira Medical Center Woodbury.
Kaprielyan expressed frustration that the terms of the debate have barely budged over the past three years.

“The science has been demonstrated,” regarding the safety of the procedures, said Kaprielyan, who’s responsible for government and external affairs for the three-hospital chain. Inspira doesn’t host emergency angioplasties at its Elmer facility and isn’t seeking to add the elective procedures there.

Kaprielyan said that the proposed state rule continues to “kick the can down the road.”

“It’s a tremendous inconvenience,” he said, for patients at the Inspira hospitals, as well as for those at Hunterdon Medical Center, the University Medical Center of Princeton at Plainsboro, and St. Clare’s Health System, to have to travel for elective angioplasties.

“It would be our hope that it would a regulatory fix but you just don’t know what will see the light of day,” Kaprielyan said, indicating that he expects legislators who represent residents in rural parts of the state to support a bill that would mandate expansion of the elective procedures.

But for David Knowlton, CEO of the nonprofit New Jersey Health Care Quality Institute, expanding the number of hospitals that perform elective angioplasties beyond 18 could be a potential danger.

While the chances for complications during an elective angioplasty are “very slim,” Knowlton said, if they do occur, “very often it’s because you’ve perforated an artery” or there’s another event that could be life-threatening.

Knowlton noted that the state has allowed some hospitals without cardiac surgeries to perform emergency angioplasties, but the public-health calculation is different for elective procedures. He indicated that the number of angioplasties would likely grow in the future as an aging population experiences heart problems.

“What (the state is) doing is putting patients at risk for market share,” by allowing some hospitals to perform elective angioplasties, Knowlton said. “We don’t see any reason to expose consumers to risk, albeit small risk, unnecessarily.”

Knowlton said that if the state does move forward with the regulation that would allow the 11 hospitals that participated in the national study to continue to offer the elective procedures, those hospitals should be required to disclose to patients that if potential complications do occur, they would be in more danger in a hospital without a cardiac surgery.

“I say, at least disclose to consumers and let them make the choice,” that they could opt to travel for a safer alternative, Knowlton said.

Knowlton added that most state residents live within a half-hour drive of the 18 hospitals with cardiac surgeries, and nearly all are within an hour.

“We’re not out in Missouri or Montana, for example, where you can’t get to the hospital,” for many hours, he said.

The Health Care Administration Board, which advises Health Commissioner Mary E. O’Dowd on regulations related to hospitals, will hold its next meeting on June 18. The agenda hasn’t been announced.